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KMK Gen Pharm > 2 - Antivirals/Fungal/Parasite, TB > Flashcards

2 - Antivirals/Fungal/Parasite, TB Flashcards

1
Q

TB

  • type of agent
  • # 1 symptom
  • active vs latent tx
A

RNA pol

Night sweats

Active = combo = (RIPE)
Latent = isoniazid or rifampin monotherapy (think chest x-ray)
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2
Q

Rifampin

  • MOA
  • adverse effects
A

Prevents mRNA synthesis (transcription) by binding to the beta subunit of DNA-dependent RNA pol

Hepatotoxicity (= incr AST and ALT) is most common
Orange-pink urine and tears (*unique)
Exudative conj-itis is rarely reported

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3
Q

Isoniazid

  • MOA
  • adverse effects
A

Prevents cell wall synth by inhibitbing mycolic acid synth

Hepatotoxicity
Pyridoxine (vit B6) deficiency -> peripheral neuropathy
Optic neuritis: rare (also optic atrophy, both leading to vision loss)

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4
Q

Ethambutol

  • MOA
  • adverse effects
A

Inhibits synth of mycobacterial cell wall by inhibiting arabinosyl transferase

OPTIC NEURITIS: RETROBULBAR, BILATERAL (pt sees nothing, dr sees nothing; 25yo with 20/200 OU)

  • complaints of reduced VA, color blindness
  • vision loss is usually reversible, may take months to normalize
  • pts should rec’v baseline and periodic assessment of VA and RG color discrimination
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5
Q

Oseltamivir

  • MOA
  • clinical indications
  • adverse effects
A

Inhibits flu A and B viral neuramidase
Prevents spread of virus along mucous lining of resp tract

Influenza therapy

Conj-itis in 1% of pts

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6
Q

Zidovudine

  • MOA
  • clinical indications
  • adverse effects
A

Nucleoside analog of thymidine - potent inhibitor of viral RNA-dependent DNA pol (reverse transcriptase)

Major component of 3-drug therapy for HIV (recall AIDS at <200 CD4)
During pregnancy to lower risk of transmission to fetus

Bone marrow suppression
Lactic acidosis
Muscle breakdown: myopathy, myositis
Amblyopia + macular edema have been reported: unknown why

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7
Q

Ribavirin

  • MOA
  • clinical indications
  • adverse effects
A

Inhibits viral RNA pol
Always used in combo with interferon

Hep C (recall A+B have vaccines, vowels are fecal-oral transmission)

Conj-itis is most common ocular SE
RIVAViriN*:
-RD
-Ischemia (CWS)
-Bleeding (heme)
-A/V occlusions
-optic Neuritis
*with long-term (9-12mo), not huge deal/usually goes away, VA okay
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8
Q

Herpes

  • type of microbe
  • MOA for ALL anti-herpetic drugs
  • examples of varients
A

DNA virus

Inhibit DNA pol

Simplex, zoster, cytomegalovirus

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9
Q

Trifluridine

  • MOA
  • clinical indications
  • adverse effects
A

Inhibits DNA pol

Herpes simplex keratitis (dendrites)
-bad dosing (9x/day)

Thimerisol preservative

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10
Q

Acyclovir, Valacyclovir, Famciclovir

  • MOA
  • clinical indications
  • adverse effects
A

Inhibit DNA pol - systemic

Anti-herpetic:

  • cold sores (HSV1)
  • genital sores (HSV2)
  • shingles (HZV)
  • HZO
  • HSV keratitis, incl prophylaxis for recurrent

HA + GI are most common, esp in pts with renal dysfunction
Elderly/immunocompromised + pts with renal/liver dz should be dosed and monitored carefully

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11
Q

HSV epithelial keratitis standard of care

A

Oral antivirals (acyclo/valacyclo/famciclo/ganciclovir, trifluridine)

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12
Q

Ganciclovir

  • MOA
  • clinical indications
  • vs Viroptic
  • adverse effects
A

Inhibits DNA pol

HSV keratitis
Intraocular sustained-release capsule for CMV retinitis

Better dosing (5x/day)
Reduced corneal toxicity (BAK preserved, not thimerosal)

Topical: blur, irritation
IV: immediate but temporary decr VA, RD, vitreous hemorrhage

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13
Q

Foscarnet

  • MOA
  • clinical indications
  • adverse effects
A

DNA pol inhibitor - administered as IV

Safety net if ganciclovir fails for CMV ret
Acyclovir-resistant HSV infections in pts with AIDS (CD4 < 200)

Nephrotoxicity
Seizures

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14
Q

Anti-fungals

  • target for most drugs
  • drugs that punch holes
  • drugs that inhibit synth
  • drug that inhibits mitosis, interferes with microtubules
A

Ergosterol: component of fungal cell walls not found in human cells (analogous to cholesterol)

NatamyCIN, amphoteriCIN B, nystaTIN

KetoCONAZOLE, fluCONAZOLE, miCONAZOLE

Griseolfulvin

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15
Q

Natamycin, Amphotericin B, Nystatin

  • MOA
  • clinical indications
A

Bind to ergosterol, forms pores

Nata: FDA approved - fungal bleph, conj-itis, keratitis; Candida, Aspergillus, Fusarium

AmphoB: broad-spec topical for fungal keratitis, IV for systemic/intraocular fungal infections

  • topical only thru compounding pharmacy
  • nephrotoxicity common with IV tx

Nyst: not indicated for ophthalmic use
-Candida oral (thrush), vaginal (yeast) infxns

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16
Q

Ketoconazole, Fluconazole, Miconazole

  • MOA
  • clinical indications
  • adverse effects
A

Inhibit ergosterol synthesis

Keto: first oral azole; severe fungal corneal ulcers, systemic infxns, acanthamoeba

Fluc: oral, topical, or subconj; incr resistance and ineffectiveness against endophthalmitis agents is concerning

Hepatotoxicity

17
Q

Griseofulvin

  • MOA
  • clinical indications
A

NOT ERGOSTEROL: inhibits fungal mitosis by interfering with microtubule formation during cell wall synth

Oral rx for scalp/skin (incl nails)

18
Q

Chloroquine

-MOA/clinical indications

A

1) build-up of heme (breakdown product of hemoglobin) within RBCs = toxic to intra-erthrocytic Plasmodium parasite (malaria)

2) inhibits phospholipase A (same as steroids) to decr inflammation for pts with RA/lupus
- not generally used as anti-inflamm due to SE

19
Q

Chloroquine

-adverse effects

A

Most common: reversible whorl keratopathy

Greatest risk to vision: bull’s eye maculopathy
-granular hyperpigmentation surr by zone of depigmentation

RPE mottling = initial sign of bull’s eye mac
-binds to melanin in RPE -> localize damage, subsequent migration of RPE to ONL/OPL

Central and paracentral scotomas are most common VFDs
Color vision is typically normal in early (mottling) stages

20
Q

Chloroquine

  • screening
  • incr risk for development of bull’s eye mac
A

10-2, SD-OCT

Dose: >2.3 mg/kg real body weight (>5 for hydroxy)
-avail doses are 200 or 400mg
Duration: 5 years
Abnormal renal func, liver dz, concomitant retinal dz
High body fat %
Age >60

21
Q

Lindane

  • MOA
  • clinical indications
  • adverse effects
A

Lipophilic structure absorbed thru exoskeleton of insects -> seizures, death

Lice, scabies

Conj-itis if shampoo tx is applied to lashes (avoid near eyes)

KMK Gen Pharm (9 decks)

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